On this first anniversary of its implementation, Obamacare has become like the weather. Everyone complains about it, but it seems – at least to the citizenry – no one is doing anything about it. But Ed Gillespie may be helping to change that.
Now, it’s not like the GOP has just been passive aggressive about Obamacare. House Republicans have voted to repeal ACA numerous times (knowing those repeals would not amount to anything), and have made concerted efforts to change or dump pieces of it. But they have been unwilling to do the two things that require the most political courage: de-funding it, and uniting behind a single alternative plan that would allow them to be purveyors of constructive change in a health care insurance system that was broken well before Obamacare, instead of just political opponents capitalizing on the low hanging fruit of Obamacare’s obvious and pervasive dysfunction.
You can’t replace something with nothing. Articulating the many bad things about a law that passed by the slimmest of margins (the lies about keeping your plan and lower costs used to pass it, excessive government control, rationing, etc.) does not constitute a concrete alternative, and the GOP has teetered on the edge of appearing to say outright that things were perfectly good with the health care system, when they clearly were not. It is dangerous to publicly pine for good old days that were not in fact good. Costs to consumers were skyrocketing thanks to a system that has been abused because of its foundation of third party payers (think of an all-you-can-eat restaurant where the patrons pay a fixed price and then gorge themselves).
Individual Republicans have proposed a number of alternative health care plans, but not a single one has drawn nearly enough legislative support to even be taken seriously. Much of this, of course, is because they know that with Obama occupying the White House until 2017, neither a repeal of ACA nor a replacement of it are politically possible.
They now need to begin thinking differently about it. With control of both houses of Congress clearly in their sights, the GOP must start planning ahead for 2016, when they stand a decent chance of controlling both houses of Congress and the presidency.
In a political season long on despair and short on positive vibes, the GOP is perfectly positioned to start exuding the type of energy it will be necessary to project if they expect to deny Hillary Clinton the oval office. The question is whether the GOP establishment which stands to gain the most from November’s elections will make serious efforts to re-brand a party that has hardly succeeded in capitalizing on the failed presidency of Barack Obama. “At least we’re not Obama” is not an enduring strategy.
So give Ed Gillespie credit. Instead of just complaining about Obamacare, the Republican candidate challenging Mark Warner for the US Senate has proposed a concrete alternative. It has its shortcomings – no single plan can completely change the trajectory of a health care insurance system that has become nonsensical – but it is so far superior to ACA that it merits serious consideration as the Republican alternative.
Even the Washington Post was willing to give Gillespie some credit…before they said his plan would, of course, be worse than the Affordable Care Act.
Gillespie favors the 2017 Project plan, brainchild of Bill Kristol. The group’s plan includes the basic component that allows competition across state lines for insurance plans – the prohibition of which is something I still can’t get anyone to explain. It also means to correct the massive subsidy people with employer based plans receive – they are not taxed on the benefit, while those who pay out of pocket are… and with after-tax dollars. The Weekly Standard offers a cogent refutation of the Post’s dismissal.
The 2017 Project plan employs refundable tax credits as opposed to mere tax deductions (tax credits are applied directly to the total you owe the government, while deductions only reduce your taxable income).
The major issue with the plan, one that will require serious study, is how much it will cost. Remember that about half of Americans pay no federal income tax, so we would be voting in a different form of government payout.
The ideal alternative would be a system centered around a broad expansion of health savings accounts, which would compel us to order from the menu instead of paying an inflated all-you-can-eat price and drive down costs by involving us in our health decisions the same as with every other commodity we purchase.
The problem Obamacare sought to correct was the 40 million people who, while not being left to die or turned away from emergency rooms, did not have health insurance. So instead of simply adding the low-income uninsured to the Medicaid rolls (the simplest solution to the problem), the President convinced a highly skeptical Congress to pass a law that completely changes the way the other 280 million Americans get their healthcare, and imposing for the first time in U.S. history an affirmative duty for all citizens to purchase a service at the direction of the Federal government. But one year into ACA, we have no idea how many of those 40 million are now actually insured because virtually all of the metrics on Obamacare are unreliable.
Last month, the CDC estimated a decrease in uninsured people of 1.3 percent since the implementation of ACA. That would mean there are about 3.8 million fewer uninsured Americans. But in this piece, Joseph Antos points out that 75% of those who had individual (non-employer-based) insurance plans saw their plans cancelled because of non-compliance with ACA mandates, and many of those (an indeterminate number) got new policies through the ACA exchanges, so it is impossible to know how many of the ACA enrollments were actually for those who were previously uninsured.
In the long run, the major reason Obamacare will continue to be a failure is that the policies it offers are not any good. Far from reducing the average costs of premiums by the promised $2500 and fulfilling the other central promise that people would get to keep their coverage and their doctor if they so desired, what people are most often getting is a mandated policy with high monthly premiums, limited coverage and most importantly (and most under-discussed), a high deductible.
There seemed to be this assumption that as long as people have a policy, any policy, they are good to go. But the New York Times, of all places, recently exposed the uselessness of policies with very high deductibles. “[T]he average deductible for a bronze plan on the exchange — the least expensive coverage — was $5,081 for an individual and $10,386 for a family, according to HealthPocket, a consulting firm. Silver plans, which were the most popular option this year, had average deductibles of $2,907 for an individual and $6,078 for a family.” This is really the equivalent of catastrophic coverage – a tin plan with a gold price tag for both the individual and the taxpayers who are footing the ACA bill.
The only way Obamacare can be spun by the left as a success is if the goal was to increase the size and scope of the federal and state governments, increase the required interaction between the citizen and the state, reduce the choices free citizens are permitted to make and further reduce the world of the voluntary in favor of the compulsory.
It is now exactly the right time for the GOP to begin getting their stories straight and uniting behind a single viable alternative that is attractive from both a policy and political standpoint. The plan articulated by Mr. Gillespie represents a good start.
